The Gables

The Gables is registered to provide accommodation and personal care for up to 13 people with a learning disability or autistic spectrum disorder. People living at The Gables have their own flat which consists of a living room, kitchen, bedroom and bathroom. There are nine flats, some single, some double. There is a small communal kitchen/dining area and living room. At the time of our inspection nine people were using the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

People received exceptional care from the registered manager and their team of support workers. Outstanding practice had been developed to provide people with care that was truly compassionate, caring and inclusive. Exceptional caring values were evident as well as a desire to provide person centred care focused around each individuals' needs and wishes.

People were empowered to be in control of their daily living. Support workers made opportunities accessible to people to fulfil their daily living as well as aspirational needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were sufficient numbers of staff who had been safely recruited. They received a regular programme of support through training, supervision and appraisal.

People’s health needs were met through a range of healthcare professionals who were involved in their care. Extremely positive outcomes were seen for people.

People were supported to maintain relationships with family, friends and other loved ones. Staff provided training and guidance for people on sexual relationships.

People were able to purchase and prepare food in their own flats, although they could access meals prepared by support workers.

Medicines were received, stored, administered and disposed of safely. Staff involved in handling medicines had received recent training around medicines and had their competency checked.

Care plans were sufficiently detailed and staff demonstrated their knowledge of people’s care needs and how risks to people were to be mitigated.

The service was well-led by a registered manager who was noted as an effective communicator who genuinely cared for the staff team. Relevant audits and other systems of governance were effective. Complaints were found to be suitably managed.

We have made a recommendation about the registered provider’s guidance relating to handling allegations of abuse.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good when we inspected (published in November 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Gables is registered to provide accommodation and personal care for up to 13 people with a learning disability or autistic spectrum disorder. People living at The Gables have their own flat which consists of a living room, kitchen, bedroom and bathroom. There are nine flats, some single, some double. There is a small communal kitchen/dining area and living room. At the time of our inspection 10 people were using the service.

The service is required to have a registered manager, and at the time of our inspection there was no registered manager in post. There was a manager and they had submitted their application to become the registered manager for the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered provider had policies and procedures in place to guide staff in safeguarding adults, and staff we spoke with understood the different types of abuse that could occur and were able to explain what they would do if they had any concerns. We found that people’s needs were assessed and risk assessments were in place to reduce risks and prevent avoidable harm.

Medication was appropriately stored, administered and recorded on medication administration records. An issue on one medication record was addressed on the day of our inspection. Staff responsible for administration of medication had received training and the registered provider completed staff competency assessments. This showed that there were systems in place to ensure people received their medication safely.

The registered provider had a safe system for the recruitment of staff and was taking appropriate steps to ensure the suitability of workers. The registered provider had systems in place to ensure there were sufficient staff available to keep people safe and meet their needs. Staff completed a range of training and received supervision and appraisal to help them carry out their roles effectively.

The registered provider sought consent to provide care in line with legislation and guidance. Staff had completed Mental Capacity Act 2005 (MCA) training and were able to demonstrate an understanding of the principles of the MCA. The registered provider ensured that any conditions on people’s Deprivation of Liberty Safeguards (DoLS) authorisations were adhered to.

People were supported to maintain good health and access healthcare services. We saw evidence in care files that people had accessed a range of healthcare services where required, such as GPs, occupational therapists, epilepsy nurses, cardiologists, dentists and the community mental health team. People received appropriate support with their nutrition and hydration and we received positive feedback about the quality and variety of food available. Staff supported people to prepare their own meals where they were able to.

People told us that the staff who supported them were caring. People also reported that they felt their privacy and dignity were respected. We saw positive and friendly interactions between staff and people who used the service. Staff promoted people’s independence wherever possible, and progress towards people’s goals in relation to the development of independent living skills, was monitored. Support was provided to enable people to maintain regular contact with family and friends and visitors were welcome at any time.

Care plans were reviewed regularly and contained information about people’s needs and preferences. Staff were also able to demonstrate a good understanding of people’s needs, in order to provide a personalised service.

There was a complaints procedure in place and people who used the service told us they knew how to raise a complaint if they needed to. People also had opportunity to raise concerns or give their views in residents meetings and through individual review meetings.

There was a quality assurance system in place, which included satisfaction surveys, monthly service audits and quarterly health and safety audits. There was evidence that systems in place had resulted in actions being identified and addressed where required.

Feedback about the management of the service was positive and comments from staff indicated there was a person-centred culture at the home. People who used the service told us they were happy living at The Gables and relatives also expressed a high level of satisfaction with the care provided.

We looked at the care records of two people and saw they were up to date and the relevant risks had been assessed. People had personal support plans which provided detailed information for staff follow in how to meet the person's personal and social needs. We saw that people had been involved in developing these supoprt plans and were consulted about the care provided.

We saw and were told that staff were supported to gain the necessary skills for their role. We saw staff were trained in areas such as administering medication, safeguarding, moving and handling and the Mental Capacity Act 2005.